If you’re inclined toward the view that society, as it is presently constituted, is all wrong and that dramatic, top-down interventions are necessary to reform not just private institutions but private behaviors, you’ve never seen a tool to achieve those ends as powerful as the pandemic.
We’re not talking about gentle “nudging” anymore. What was needed were blunt instruments and a willingness among elected officials to use them. And that’s what we got.
But it wasn’t long before it dawned on social reformers that the holistic approach policymakers took to addressing this crisis could be applied to any number of conditions that have some tangential relationship to public health. It’s a concept that the researchers who composed one study published in the American Journal of Public Health took to calling “Public Health 3.0.” What is needed is a “greater emphasis” on a “systems approach” for “addressing social detriments of health that more fully considers the interconnections between risk factors, the environment, and social and economic factors.” Which is to say, anything and everything.
A disequilibrium in available housing and disparate modes of transportation is a public health crisis if you think about it. Economic inequalities most certainly contribute to negative health outcomes and are, therefore, within the medical realm. America’s vestigial attachments to autonomy and privacy surely contributed to the lack of an effective contact tracing regime over the pandemic’s course, so our legal conventions are a factor when thinking about detriments to public health. And, of course, racial discrimination—both the active sort and its legacy effects—are a public health crisis.
Racial disparities as observed in the outcomes of people who suffered with or succumbed to COVID-19 aren’t something policymakers should take lightly. As public health researcher Abdullah Shihipar wrote in a March 7 New York Times op-ed, “Black and Latinx” demographics are overrepresented in the number of COVID-related hospitalizations. Native Americans have died from the disease at more than twice the rate of white people. These disparities are agonizing. And to the extent that such a thing is knowable, they are rooted partly (though not wholly) in historical, economic, and social factors that are so numerous and interwoven that you could just as well consider their suffering a product of America’s very theory of social organization. Thus, Shihipar insisted, the “Department of Health and Human Services should declare racism a public health emergency.”
“It’s well known that structural racism is behind the massive disparities in Covid-19 infection, death and vaccination,” Shihipar concluded. “A declaration on this issue would be the first step toward fixing the problem.”
If we are to judge by the speed with which American cities and counties raced to declare racism a public health emergency in the summer of 2020, this is not a new or especially unpopular idea. America’s major metros raced to align themselves with declarations issued by organizations like the American Public Health Association and the American Medical Association, which both affirmed that racism, “intentional or unintentional,” is a “barrier to health equity.”
Well-meaning social reformers have set lofty goals for success in a public health-style anti-racism campaign. “The fact is, when we no longer see a gap in life expectancy by race and ethnicity in this city, in this state, in the nation, we’ll know that we’ve finally overcome racism,” said former New York City Commissioner of Health Mary Bassett. “Overcome racism.” This is a peculiar sort of myopia, but one with which critical observers of pandemic-related public policy have become accustomed. No one would observe the elimination of casual discrimination, economic disparities, representation deficits in media, or half a dozen other real racial phenomena in a survey of actuarial tables.
What’s more, the theory of racism as a public health crisis does not comport with how this ideal was actually practiced over the course of the pandemic. More often than not, the public-relations campaign in favor of this ideal was deployed not as a way to augment existing public health guidelines but to circumvent them.
Amid the outpouring of public grief and anxiety that followed George Floyd’s killing during an altercation with Minneapolis police, the public health establishment affirmed that COVID-related mitigation strategies were, in fact, an obstacle to the pursuit of racial rapprochement. “Suddenly,” a revealing headline in Politico read, “public health officials say social justice matters more than social distance.” That article quoted a variety of public health officials “who loudly warned against efforts to rush reopening but [are] now supportive of mass protests.” As one open letter signed by more than 1,000 epidemiologists, doctors, social workers, medical students, and healthcare professionals put it, “pervasive racism” was the “paramount public health problem” facing the nation.
That was all the permission blue-state elected officials needed to reverse what had been their inviolable commitment to preventing dangerous public gatherings. Governors like New Jersey’s Phil Murphy and Michigan’s Gretchen Whitmer, and mayors including New York City’s Bill de Blasio, suddenly countenanced assemblies that they’d previously discouraged by imposing fines and summonses on violators. And as the rigid enforcement of proscriptions on public gatherings melted away, 2020’s long, hot summer began.
The demographics most likely to have been displaced from work, educational institutions, or other salubrious occupations resumed their aborted social lives in the streets. With little to do than drink alcohol and commiserate over society’s endemic abuses, those protests soon turned violent. Some 140 American cities experienced widespread rioting. At least six people were killed in violence that resulted in national guard deployments in 21 states. Between $1 and $2 billion in paid insurance claims were estimated to have resulted from the widespread looting and vandalism that followed—eclipsing the record set by Los Angeles’s 1992 riots.
If any of this constitutes a public health crisis, we didn’t hear about it from the public health bureaucracy. In fact, it increasingly seems like the definition of what constitutes “health” has ballooned beyond the scope of anything we can wrap our hands around. But when you’ve convinced yourself that society as a whole presents a public health risk, a complete lack of perspective is no vice.